Follow-Up Specialist, Clinical Denials

POSITION SUMMARY

The Follow-Up Specialist, Clinical Denials is responsible for managing clinical appeals by engaging with insurance companies, submitting disputes, and ensuring timely resolution. This role involves investigating denial reasons, communicating with payers, and providing supporting documentation to facilitate reconsideration. The specialist works closely with the operations team to escalate appeal denials while independently handling administrative disputes. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

• Review denial letters and initiate follow-up actions to confirm and dispute appeal denials.
• Contact insurance companies via phone, payer portals, and email to clarify denial reasons and request reconsideration.
• Submit disputes for denials related to timely filing, missing documentation, or administrative errors.
• Provide supporting documentation such as USPS printouts, fax confirmations, email delivery receipts, and tracking numbers to validate timely appeal submission.
• Monitor outstanding appeals and escalate unresolved cases in accordance with payer contract guidelines.
• Track pending decisions and proactively follow up if no response is received within contractually defined timeframes.
• Maintain detailed records of follow-up efforts, payer responses, and dispute outcomes.
• Delivers excellent outcomes through collaborative teamwork, continuous improvement, and a client-first approach—while contributing to an engaging, positive team culture.
• Ability to accept and apply feedback to build proficiency in all responsibilities listed and adapt to changes in processes, priorities, and organizational needs.
• Achieves all established departmental performance and production targets, ensuring work is completed accurately and meets departmental expectations for output and efficiency.
• Other duties as required.

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 2-3 years’ experience in healthcare field working in billing or collections.
• 1+ years’ customer services experience.
• Knowledge of insurance payer/provider claims processing and subsequent data requirements.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Strong interpersonal and communication skills, with the ability to collaborate effectively with team members and cross-functional teams.
• Knowledge of the revenue cycle process.
• Timely and regular attendance.
• Equivalent combination of education and experience will be considered.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

• Practices and adheres to EnableComp’s Core Values, Vision and Mission.
• This role is primarily office-based, depending on company policy, with extensive computer, phone, and document review work.
• Ability to sit for extended periods while making calls and reviewing denial documentation.
• Visual acuity to read and analyze medical records on screens and in printed formats.
• Ability to meet benchmarks and handle time-sensitive workloads in a high-volume environment.
• Proven written and verbal communication skills.
• Strong analytical and problem-solving skills.
• Ability to prioritize and manage multiple competing priorities and projects concurrently.
• Expected to exercise sound judgment when escalating disputes or transferring cases.
• Must be able to remain in stationary position 50% of the time.
• If working onsite, may occasionally move about inside the office to access office equipment, etc.
• Constantly operates a computer and other office equipment.